Cheng Yalin, Li Huimin, Yang Chenguang, Gao Haiyang, Li Peng, Zhu Wanrong, Lu Yuzhu, Ji Fusui, Yu Xue, Zhang Wenduo
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
BMC Geriatr. 2025 Jul 2;25(1):460. doi: 10.1186/s12877-025-06111-4.
The fibrinogen-to-albumin ratio (FAR), a novel inflammatory marker, has demonstrated prognostic utility in cardiovascular diseases. However, its role in risk stratification among oldest-old patients (≥ 80 years) undergoing percutaneous coronary intervention (PCI) remains poorly established.
This single-center retrospective cohort study enrolled 641 consecutive patients aged ≥ 80 years with coronary artery disease who underwent PCI between 2015 and 2021. Based on the median FAR value (0.079), patients were divided into higher FAR and lower FAR groups. The endpoints were cardiovascular and all-cause mortality. Multivariable Cox models and restricted cubic splines assessed the associations between FAR and endpoints.
During a median follow-up of 61 months, 237 deaths (37%) were recorded, of which, 124 (19.3%) were due to cardiovascular disease. The 1-year mortality was 9.3% and 5-year mortality was 27.4%. Kaplan-Meier analysis demonstrated higher FAR levels were significantly associated with increased risk of both cardiovascular and all-cause mortality (log-rank p < 0.001). According to the restricted cubic spline, the association between FAR and mortality was J-shaped. Higher FAR (> 0.079) independently predicted cardiovascular mortality (adjusted HR = 1.49, 95% CI:1.01-2.19, p = 0.045). When tested as a continuous variable, higher FAR levels were associated with a higher risk of cardiovascular (HR = 1.23, 95% CI: 1.04-1.47, p = 0.018) and all-cause mortality (HR = 1.12, 95%CI: 0.98-1.27, p = 0.090) in fully adjusted models. Subgroup analysis revealed that the association between higher FAR levels and increased cardiovascular mortality was significantly stronger in patients with triple-vessel disease (interaction p = 0.039). The associations between FAR and cardiovascular mortality remained robust in the Fine and Gray competing models (HR = 1.31, 95%CI: 1.13-1.52, p = 0.003).
Higher FAR levels are associated with increased risks of cardiovascular and all-cause mortality in oldest-old patients undergoing PCI. These findings support the potential of FAR for risk stratification in geriatric cardiology.
纤维蛋白原与白蛋白比值（FAR）作为一种新型炎症标志物，已在心血管疾病中显示出预后价值。然而，其在接受经皮冠状动脉介入治疗（PCI）的高龄患者（≥80岁）风险分层中的作用仍未明确。
这项单中心回顾性队列研究纳入了2015年至2021年间连续641例年龄≥80岁且患有冠状动脉疾病并接受PCI的患者。根据FAR中位数（0.079），将患者分为FAR较高组和FAR较低组。终点为心血管死亡率和全因死亡率。多变量Cox模型和受限立方样条评估FAR与终点之间的关联。
在中位随访61个月期间，记录到237例死亡（37%），其中124例（19.3%）死于心血管疾病。1年死亡率为9.3%，5年死亡率为27.4%。Kaplan-Meier分析表明，较高的FAR水平与心血管和全因死亡率风险增加显著相关（对数秩检验p<0.001）。根据受限立方样条，FAR与死亡率之间的关联呈J形。较高的FAR（>0.079）独立预测心血管死亡率（调整后HR=1.49，95%CI：1.01-2.19，p=0.045）。作为连续变量进行检验时，在完全调整模型中，较高的FAR水平与心血管疾病（HR=1.23，95%CI：1.04-1.47，p=0.018）和全因死亡率（HR=1.12，95%CI：0.98-1.27，p=0.090）风险较高相关。亚组分析显示，在三支血管病变患者中，较高的FAR水平与心血管死亡率增加之间的关联显著更强（交互作用p=0.039）。在Fine和Gray竞争模型中，FAR与心血管死亡率之间的关联仍然稳健（HR=1.31，95%CI：1.13-1.52，p=0.003）。
在接受PCI的高龄患者中，较高的FAR水平与心血管和全因死亡率风险增加相关。这些发现支持FAR在老年心脏病学风险分层中的潜力。
